FRATERNAL ORDER OF POLICE LODGE #81
WNC MACON JACKSON COUNTY, FRANKLIN, NC
APPLICATION FOR MEMBERSHIP - ACTIVE/AFFILIATE/ASSOCIATE
To the Officers of the Fraternal Order of Police Lodge #81:
I, the undersigned, apply for ( ) membership with WNC-Macon Jackson County FOP Lodge #81. I certify that I am (ACTIVE LAW ENFORCEMENT), (RETIRED LAW ENFORCEMENT) , (SUPPORT PERSONNEL), OR (INTERESTED CITIZEN OR RESIDENT)
I understand and do authorized the membership committee of said lodge to contact my sponsor, previous employer of other sources so that a determination can be made as to my background and qualifications to be a member
If my membership, after acceptance or approval, should be revoked or discontinued for any cause other than retirement while in good standing, I do hereby agree to return to said Lodge my membership card and any other material bearing the FOP insignia, such as auto emblem, lapel pin, etc.
Signed: __________________________________ Date: _______________
PLEASE PRINT THE FOLLOWING INFORMATION
NAME: ___________________________________ EMAIL ADDRESS: __________________________
ADDRESS: _____________________________ CITY: _______________________ STATE: ________
HOME PHONE: _________________ DATE OF BIRTH: ______________ SS#: __________________
REPRESENTING DEPARTMENT OR OCCUPATION: ___________________________________________
TRANSFER FROM OTHER LODGE: LODGE# ________ CITY: __________________ STATE: ______
DUES ARE PAID ANNUALLY AND PRORATED FROM NOVEMBER 1ST
(ASSOCIATE MEMBER DUES ARE PAYABLE ANNUALLY ON MEMBERSHIP ANNIVERSARY)
MAKE YOUR CHECK PAYABLE TO FOP LODGE #81 NC
RECOMMENDED BY: ________________________ CONTACT PHONE: ________________
BACKGROUND OR QUALIFICATIONS VERIFIED BY: ____________ DATE: ________________
MEMBERSHIP COMMITTEE RECOMMENDATION: _______ LODGE RECOMMENDATION: ________
APPROVED MEMBERSHIP EFFECTIVE: ___________________ APPLICATION # ______________
LODGE ADDRESS
FOP LODGE #81
POST OFFICE BOX 12
FRANKLIN, NC 28744